肉眼观察与组织学检查在确诊盆腔子宫内膜异位症中的作用

Objective: To obtain histologic confirmation of lesions suspected of endometriosis at laparoscopy. Design: Prospective clinical study. Setting: Patients in an academic hospital. Patient(s): Women of reproductive age who complained of chronic pelvic pain. Intervention(s): A total of 122 biopsies were obtained from 54 patients undergoing laparoscopy, after exclusion of other potential causes of pelvic pain. Main Outcome Measure(s): Lack of consistency between laparoscopic and histologic diagnosis of endometriosis, in particular for minimal/mild stages. Result(s): Endometriosis was confirmed by histology in 54% of the excised lesions. Diagnosis was more often confirmed among classic lesions than for all atypical lesions considered together. The histologic diagnosis of fibrosis was the most common among those biopsies, which lacked the presence of endometriosis. The revised American Fertility Association (AFS) scores before and after histologic confirmation differed significantly. In particular, 20 patients in either revised AFS class Ⅰ or Ⅱ were down-graded to stage 0. No single anatomical site turned out to be particularly prone to misdiagnosis at laparoscopy, in comparison to the other sites. Conclusion(s): These results confirm the need of histologic confirmation to obtain a diagnosis of endometriosis. However, the clinical impact of such findings remains a matter of debate.

根据小型活检标本肺癌组织学分型诊断的可靠性

根据小型活检标本肺癌组织学分型诊断的可靠性任少华，徐少杰，黄渊不同组织类型的肺癌需要采用不同的治疗方法，才能取得良好疗效。但在临床工作中往往只能根据经纤支镜或经皮肺穿刺活检的小型标本进行组织学分型诊断，并根据报告做出治疗决定。本文就小型活检标本分型诊...

癌症病人T细胞集落形成能力

癌症病人血清中存在抑制免疫功能的物质,已不断见诸报道。但利用T细胞集落(CFU-TL)结合血清免疫抑制活性存在情况的研究,则尚未见报道。我们采用T细胞集落甲基纤维素微量培养方法。

高频超声引导下胸膜活检对渗出性胸腔积液诊断价值

目的:探讨高频超声引导下胸膜活检对渗出性胸腔积液的诊断价值。方法:回顾性分析2018年1月至2019年5月我院接受诊断的良恶性胸腔积液患者70例,其中高频超声引导下胸膜活检为35例为观察组,胸腔镜下胸膜活检患者35例为对照组。统计两组患者的取材成功率,病理阳性率,及检测后并发症的发生情况以及检测安全性。结果:高频超声引导下胸膜活检的取材成功率为100.0%,明显高于胸腔镜下活检的80.0%,数据间有明显的统计学差异产生(P<0.05);高频超声引导下胸膜活检良性病理阳性率高于胸腔镜下胸膜活检方式,存在统计学层面的数据差异(P<0.05);高频超声引导下胸膜活检出现并发症的概率为2.9%,与胸腔镜下胸膜活检相比,差异有统计学意义产生(P<0.05)。结论:高频超声引导下胸膜活检可提高渗出性胸腔积液的诊断价值,推广应用价值高。

Ⅰ或Ⅱ期子宫癌肉瘤(混合中胚层肿瘤)全切患者术后辅以异环磷酰胺和顺铂化疗的疗效:一项GOG研究

Objectives. To determine progression- free survival (PFS) and overall survival (OS) in women with completely resected stage I or II carcinosarcoma of the uterus treated with adjuvant ifosfamide and cisplatin, and to assess the toxicity of this regimen. Methods. Eligible patients had histologically confirmed carcinosarcoma (mixed mesodermal tumor) and no postoperative radiotherapy following complete resection for clinical stage I or II disease. They were to have adequate renal, hepatic, and hematologic functions and performance status of 2 or less. Study entry was to be within 8 weeks of hysterectomy. Patients with previous chemotherapy, or other noncutaneous malignancies, were ineligible. Ifosfamide was administered 1.5 g/m2 intravenously (IV) over 1 h and cisplatin was given 20 mg/m2 over 15 min followed by mesna 120 mg/m2 IV bolus, then 1.5 g/m2/24 h as a continuous infusion. Initial doses (daily × 5 every 21 days × 3 cycles) were reduced by 20% (to 4 days) for myelotoxicity. Results. Nine of seventy- six patients enrolled were deemed ineligible and another two who did not receive protocol treatment were inevaluable. Of the 65 evaluable patients, median age was 65 years; 50 patients (77% ) were stage I and 15 (23% ) were stage II. PFS and OS, respectively, were 69% and 82% at 24 months, and 54% and 52% at 84 months. Overall 5- year survival was 62% . Leukopenia was the most commonly reported, but manageable, toxicity. Conclusion. Adjuvant ifosfamide and cisplatin after primary surgery for stage I or II carcinosarcoma of the uterus is tolerable. In the absence of concurrent controls, the impact on PFS and OS is unclear. Pelvic relapse remains problematic.

窄带紫外线B光线疗法治疗和维持治疗蕈样霉菌病患者

Background and purpose:Narrowband ultraviolet B (UVB)phototherapy for early-stage mycosis fungoides (MF) has been found to be beneficial in some reports. Although rapid recurrences after discontinuation of therapy appear to interfere with its efficacy, optimal maintenance schedules for prolonged relapse-free intervals are not discussed in the literature. The purpose of this study was to review our experience with narrowband UVB in patients with MF. Patients and Methods:All available data that belong to 14 patients (10 male, 4 female; age range, 28-74 years) with histologically proven MF, at disease stages IA-IB (n=10) and IIA (n=4) who received narrowband UVB were retrospectively evaluated. Results:Complete response (CR) was achieved in 11 of 14 cases (78%) after a mean of 25 treatments. Ten of 11 patients were followed up for a median of 22 months (range, 7-43 months) after CR; one patient was lost to follow-up immediately after CR. Eight patients completed the recommended maintenance narrowband UVB therapy protocol. The median duration of maintenance was 18 months (range, 12-30 months). No patient had relapse during maintenance. Mean relapse-free duration was 26.0±9.9 months. Limitations:The number of patients in the study group was relatively few. Conclusion:This study provides evidence that narrowband UVB might be an efficient treatment option for MF patients at stages IA and IB, as well as at stage IIA. Results suggest that using maintenance phototherapy after CR is a logical approach, which may prolong the duration of remission in MF.

变异型克-雅病的神经心理学特征:遗传性和散发性朊蛋白病患者的对照研究

Objective: To assess cognitive function in variant Creutzfe- ldt-Jakob disease (vCJD). We describe the neuropsychological profiles of 10 c ases and compare these data with cross sectional data obtained from patients wit h histologically confirmed sporadic CJD and cases with inherited prion disease w ith confirmed mutations in the prion protein gene. Methods: Patients referred to the Specialist Cognitive Dis orders Clinic at the National Hospital for Neurology and Neurosurgery and the National Prion Clinic at St Mary’s Hospital, London for further investigation o f suspected CJD were recruited into the study. The neuropsychological test batte ry evaluated general intelligence, visual and verbal memory, nominal skills, lit eracy skills, visual perception and visuospatial functions, and visuospatial and executive function. Results: The results indicate that moderate to severe cogni tive decline is a characteristic feature of vCJD. Specifically,verbal and visual memory impairments and executive dysfunction were pervasive in all disease grou ps. Nominal skills were impaired in variant and sporadic CJD, significantly so w hen compared with the inherited prion disease group. Perceptual impairment was l ess frequent in the vCJD group than in the sporadic and inherited groups. Conclu sion: This study confirms the occurrence of generalised cognitive decline in pat ients with vCJD. Although decline in cognitive function ultimately affects all d omains, there is a suggestion that some components of visual perception may be s pared in vCJD. The results also suggest that nominal function may be preserved i n some cases with inherited prion disease.

吡美莫司乳膏外用治疗早期蕈样肉芽肿

蕈样肉芽肿是皮肤病中最常见的一种T细胞淋巴瘤,该研究在2015年3月1日—2016年9月30日期间,共招募了39例组织学确诊的早期(ⅠA~ⅡA期)蕈样肉芽肿患者(中位年龄51.5岁,62%的男性),患者在皮损处涂抹1%吡美莫司乳膏,每日2次,持续16周,随访12个月。主要终点是总缓解率,中位随访了5.7年。22例(56%)患者获得了缓解(1例完全缓解,21例部分缓解)。

老药新用抗肿瘤

近年来,发现某些老药具有一定的抗肿瘤作用。现将其归纳如下,以供临床用药参考。 1.黄体酮黄体酮为孕激素,临床主要用于保胎。陈氏等报道应用黄体酮治疗晚期、复发或其它治疗无效的子宫内膜腺癌,有效率达30～50％。适应症为;

内镜与EUS对胃肠上皮下肿瘤的评估比较:一项前瞻性研究

Background: The purpose of this study is to prospectively evaluate the performance characteristics of endoscopy and EUS in the diagnosis of GI subepithelial masses. Methods: A total of 100 consecutive patients referred for the evaluation of a suspected GI subepithelial lesion were prospectively studied with endoscopy followed by EUS. Size, color, mobility, location (intramural or extramural), consistency (solid, cystic, or vascular), and presumptive diagnosis were recorded at the time of endoscopy. EUS then was performed, and size, echogenicity, location, and presumptive diagnosis were determined. Results: A total of 100 subepithelial lesions were evaluated. Endoscopy had 98% sensitivity and 64% specificity in identifying intramural lesions. Size measurement by endoscopy correlated with size measurement by EUS (r = 0.88). Histology was obt-ained in 23 cases, with the presumptive EUS diagnosis correct in only 48% of cases. Most incorrect EUS diagnoses occurred with hypoechoic 3rd and 4th layer masses. Conclusions: Endoscopy has high sensitivity but low specificity in identifying the location (intramural or extramural) of subepithelial lesions. In addition, EUS imaging alone is insufficient to accurately diagnose 3rd and 4th layer hypoechoic masses, and histologic confirmation should be obtained whenever possible.

羊水栓塞报道2例(法)

We report two cases of amniotic fluid embolism, confirmed by histological examination. Both patients had an immediate post-partum haemorrhage that required an haemostatic hysterectomy. A typical symptomatology of amniotic fluid embolism revelated the first case. The patient survived without any sequelae. In the second case, amniotic fluid embolism occurred immediately after the delivery. The patient developed an acute respiratory distress with a shock syndrome. Despite haemostatic hysterectomy and resuscitative efforts, she died 6 days later.

如何合理使用抗癌药?

1.先诊断再用药所有使用抗癌药物的临床患者,必须经病理组织学确诊后方可使用。如果采用靶向药物,事先必须进行基因检测。2.在专业医生、药师指导下用药对于诊断明确的癌症患者,如果是规范化治疗,那么就需要医生、药师们按照指南的建议,为患者选择合适的药物、确定的用法及合理的周期进行治疗;如果为试验性治疗,需要医生、药师们遵循医学伦理的相关规定,为患者制定完善的临床研究方案,并选择相应的药物进行治疗。

对比-增强宽频谐波超声影像:一种定量评估克罗恩病患者肠壁血供的新技术

Objective. To assess the possibility of quantitative determination of bowel wall vascularity using contrast-enhanced (SonoVue ) wideband harmonic imaging ultrasound and the HDI-Lab software in patients with Crohn’ s disease. Material andmethods. Twenty-one patients (13 F, 8 M, average age 33.8 ± 12.7 years, range 21-60 years) with histologically confirmed Crohn’ s disease and bowel wall thickness≥ 5mm were recruited for the study. All ultrasound examinations were performed using a Philips HDI 5000 scanner. Bowel wall vascularity was determined at the site of maximum bowel wall thickness at baseline and at 30, 60, 90 and 120 s following application of the contrast enhancer SonoVue (1.2 ml) using the HDI-Lab software. Results. The mean length of bowel segments exhibiting increased wall thickness was 122.3 mm (range: 23-350 ± 74.7 mm), with a mean wall thickness of 7.6 ± 1.2 mm. Onset of echo enhancement secondary to contrast medium application was observed after an average 13.4 s (range 7-19 ± 4.2 s).Echo intensity corresponding to maxi.mum vascularity was measured 30 s after application of contrast medium. Maximum average contrast medium uptake was 217.5% (range 118-466 ± 100.1% ). Conclusions. It is possible to quantify bowel wall vascularity accurately in patients with Crohn’ s disease using contrast-enhanced pulse inversion ultrasound (low-MI).

胰管腺癌患者能否存活:一项对芬兰癌症登记数据进行再评估的全国性研究

Background: Worldwide survival data for ductal adenocarcinorna of the pancrea s are the lowest among the 60 most frequent types of organ cancers. Hence publis hed data on long time survivors of this disease are controversial. We performed a nationwide study comprising all Finnish patients diagnosed with pancreatic can cer in the period 1990- 1996 who survived for at least five years after diagnos is. Methods: Data on patients registered as five year survivors of pancreatic ca ncer were obtained from the Finnish Cancer Registry and Statistics Finland. Slid es or paraffin blocks were collected from patients recorded as having histologic ally proven pancreatic ductal adenocarcinorna (PDAC) and were re- evaluated in a double blind fashion by three pathologists with special expertise in pancreati c pathology. Results: Between 1990 and 1996, the Finnish Cancer Registry recorde d 4922 pancreatic cancer patients, 89 of whom survived for at least five years. Reviewing this series of patients revealed 45 (49% ) non- PDACs and 18 cases w ithout histological verification. In 26 patients recorded as having histological ly proven PDAC, re- evaluation of histological specimens confirmed PDAC in only 10 patients. Conclusions: This study indicates that (1) the prognosis of PDAC r emains poor and (2) careful histopathological review of all patients with pancre atic cancer is mandatory if survival data are to be meaningful.

多光谱数字阴道镜宫颈上皮内癌变体内检测的预试验结果

Fluorescence spectroscopy is a promising technology for the detection of cervical squamous intraepithelial precancers and cancers. To date, many investigators have focused on point spectroscopy as an adjunct to diagnostic colposcopy. A device that visualizes the whole field of the cervix is needed for screening. To that end, we have developed a multispectral digital colposcope that works through the colposcope to image with white light, UV excitation at 345 nm, and blue light at 440 nm excitation. Here, we report the pilot study that precedes a Phase I trial. Methods. The MDC system is composed of a light source, a colposcope, and a video rate color CCD camera with a frame grabber and takes approximately less than 1 min to make images of the cervix. Patients were measured at baseline and after acetic acid placement with white light, 345 nm excitation, and 440 nm excitation from the xenon arc lamp. The white light is in the visible spectrum, 345 nm excitation is in the UV spectrum and is not visible, and 440 nm excitation is blue light in the visible spectrum. White light generates a pink image of the cervix. 345 nm excitation, the UV light, excites fluorophores to emit a blue image. 440 nm excitation, the blue light, excites fluorophores to emit a green image. The patients underwent a loop excision procedure and the histopathology was inked and cut into 12 sections by the study pathologists. The histopathologic slides were scanned and the images were then reconstructed into maps. A diagnostic algorithm was calculated. The data were preprocessed, transformed, and analyzed by the K-means clustering method. Disease maps were generated using the algorithm and classifier and compared to white light colposcopy and the blue and green images obtained at 345 and 440 nm. Results. Forty-six patients were measured at four clinical sites. Images were made of the cervix with white light, 345 nm excitation, and 440 nm excitation and are presented in the figures. As the study went on, images improved with improvements in the instrument. The white light and fluorescence images are presented with crudely constructed histopathologic maps and algorithmic maps. At 345 nm excitation, the UV light, histologically confirmed CIN appears darker blue; while at 440 nm excitation, the blue light, histologically confirmed CIN appears lighter green. Conclusions. This pilot study shows that MDC images can be matched to both histopathologic and algorithmic maps. The device and the algorithm are evolving but show promise. A Phase I trial is planned.

体重、体重指数与卵巢癌风险:中国的一项病例对照研究

Objective. To investigate the association between ovarian cancer risk and body height, weight, and BMI. Methods. A hospital-based case-control study was conducted in China from 1999 to 2000. The study sample included 254 cases with histologically confirmed epithelial ovarian cancer and 652 controls. Information of adult height and weight at diagnosis, at 5 years before diagnosis and at age 21 years, was collected by face-to-face interview using a structured questionnaire. Odds ratios (ORs) and 95% confidence intervals (CIs) were obtained using unconditional logistic regression analyses. Results. The ovarian cancer risk was significantly increased with higher body weight and BMI at 5 years before diagnosis, but not at diagnosis nor at age 21 years. The adjusted ORs were 1.67 (95% CI = 1.04- 2.67) for body weight >60 kg versus ≤ 50 kg and 1.75 (95% CI = 1.13- 2.72) for BMI ≥ 25.0 versus 18.5- 21.9 at 5 years before diagnosis. There was no association between body height and ovarian cancer risk. Conclusion. Pre-morbid body weight and BMI were associated with an increased risk of ovarian cancer in Chinese women.

Natural history of cytomegalovirus infection in a series of patients diagnosed with moderate-severe ulcerative colitis

AIM： To evaluate the natural history of human cytomegalovirus （HCMV） infection in a series of 28 ulcerative colitis patients in whom the search for HCMV was positive. METHODS： A series of 85 patients with moderate-se- vere ulcerative colitis flare-up were evaluated for a HCMV search by performing a haematoxylin and eosin stain, immunohistochemical assay and nested polymerase chain reaction on rectal biopsies. Among 85 screened patients （19 of whom were steroid resistant/dependant）, 28 were positive for HCMV; after remission the patients were followed up clinically and histologically. RESULTS： Among the 22 patients with complete follow- up, in 8 （36%） patients HCMV-DNA persisted in the in- testinal specimens. Among the HCMV positive patients, 4 （50%） experienced at least one moderate-severeflare-up of colitis without evidence of peripheral HCMV. Among the 14 HCHV negative patients, 3 with pouches developed pouchiUs and 5 out of 11 （45%） experienced a colitis flare-up. CONCLUSION： Our preliminary results suggest that HCHV may remain in the colon afber an acute coltis flare- up despite remission; it seems that the virus is not responsible for the disease relapse.

Vimseltinib与安慰剂治疗腱鞘巨细胞瘤的临床研究

腱鞘巨细胞瘤(tenosynovial giant cell tumour,TGCT)是一种局部侵袭性肿瘤,目前很少有系统性治疗方法。MOTION研究评估了开关控制、集落刺激因子-1受体(colony-stimulatingfactor-1receptor,CSF1R)口服抑制剂vimseltinib对不适合手术的有症状TGCT患者的疗效和安全性。MOTION是一项多中心、随机、双盲、安慰剂对照的3期试验,在13个国家的35家专科医院进行。符合条件的患者为经组织学确诊为TCCT的成年人(年龄≥18岁),手术切除可能会加重功能限制或导致严重发病率。患者通过交互式反应技术随机分配(2:1)接受vimseltinib(每周两次口服30mg)或安慰剂治疗,以28天为一个周期,持续24周。除非之前确认疾病进展,否则患者和研究者在第25周之前都不知道治疗分配情况。

二代测序技术在淋巴瘤基因克隆重排毛细管电泳法判读困难病例中的对比研究

目的探讨二代测序技术在淋巴瘤基因克隆重排毛细管电泳法判读困难病例中的应用价值。方法收集组织学确诊为淋巴瘤且经毛细管电泳重排检测查见低扩增峰造成判读困难的病例,使用二代测序技术检测并对比二者结果。结果IgH克隆性重排检测24例,二代测序检出15例(62.5%,15/24),毛细管电泳检出3例(12.5%,3/24);IgK克隆性重排检测22例,二代测序检出13例(59.1%,13/22),毛细管电泳检出10例(45.5%,10/22);TRG克隆性重排检测27例,二代测序检出14例(51.9%,14/27),毛细管电泳检出6例(22.2%,6/27)。结论毛细管电泳和二代测序都可有效分析基因克隆性重排,当毛细管电泳检测低水平克隆病例判断困难时,可采用二代测序分析具体重排序列占比,进一步明确基因重排克隆的情况,为淋巴瘤病理诊断提供更多佐证。

饮食因素和前列腺癌

流行病学研究发现,饮食因素和前列腺癌间存在一定相关性,为此,进行病例-对照研究以了解饮食因素及肥胖与前列腺癌之间可能存在的相关性。收集90例男性患者,年龄50～88岁,均经组织学确诊前列腺癌。另集180例其它泌尿系疾病或泌尿系原发性肿瘤患者为对照。将摄食内容分5类:正常饮食,富动物脂肪饮食,富植物脂肪饮食。